Accounts Receivable, Adjudication, Analysis Skills, Benchmarking, Billing, Communication Skills, Community Health, Contract Requirements, Detail Oriented, Documentation, Establish Priorities, Healthcare, Healthcare Reimbursement, Insurance, Insurance Claims, Medicaid, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Quality Management, Regulations, Regulatory Compliance, Reimbursement, Revenue Management, Revenue/Sales Reporting, Root Cause Analysis, Time Management, Trend Analysis, User Interface/Experience (UI/UX), Writing Skills
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Job Type
Full-time
Description
Reporting to the Revenue Cycle Manager, the Insurance Accounts Receivable (A/R) Specialist will support the organization's revenue cycle operations. This role is responsible for the timely follow-up and resolution of outstanding insurance claims across Medicaid and commercial payers, ensuring accurate reimbursement and minimizing aged receivables.
The A/R Specialist will conduct detailed account analysis, address claim denials and underpayments, and collaborate with internal teams to identify and resolve barriers to payment. This position requires a strong understanding of payer guidelines, attention to detail, and the ability to manage a high-volume work queue while maintaining quality and compliance standards.
Essential Functions, Duties and Responsibilities
- Perform timely and thorough follow-up on assigned insurance A/R accounts (Medicaid and commercial)
- Analyze and resolve claim denials, rejections, and underpayments in accordance with payer policies and contractual requirements
- Initiate and track appeals, corrected claims, and reconsiderations through final resolution
- Utilize payer portals and direct payer communication channels to obtain claim status and facilitate resolution
- Identify trends and root causes impacting reimbursement and escalate systemic issues as appropriate
- Maintain accurate, detailed, and audit-ready documentation of all account activity
- Collaborate with front-end, coding, and billing teams to resolve upstream issues affecting claims adjudication
- Prioritize workload effectively to address aging accounts and high-dollar balances
- Consistently meet established productivity, quality, and timeliness benchmarks
Requirements
Knowledge, Skills and Abilities
- Experience with eClinicalWorks (eCW)
- Prior experience in an FQHC or community health center setting
- Familiarity with payer denial trends and reimbursement regulations impacting healthcare organizations
- Timely and consistent resolution of assigned A/R inventory
- Reduction in aged receivables, particularly accounts over 90 days
- Demonstrated ability to independently move accounts toward resolution
- High-quality, compliant, and audit-ready documentation
- Consistent achievement of productivity and quality benchmarks
- Proven ability to independently manage a high-volume A/R inventory
- Strong analytical, organizational, and problem-solving skills
- Effective written and verbal communication skills, including payer interaction
- Proficiency with payer portals and revenue cycle systems
Education, Training and Experience
- Minimum of 2 years of experience in insurance A/R follow-up within a healthcare setting
- Demonstrated experience resolving denials and appeals through to completion, not solely performing status checks
- Working knowledge of:
- Medicaid (New Jersey experience preferred)
- Commercial payer reimbursement methodologies and denial processes
Salary Description
$27.00 to $31.30 per hour
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ZUFALL HEALTH CENTER, INC.